'~aKH TO KNOW,,

Helping Children and Youth with Self-Harm Behaviours

Information for Parents and Caregivers

What’s happening with Mary? Part 1

Mary is a teenager who has always been a little quiet and shy, so her mother was surprised
when she found out that Mary started dating a boy this year. But lately, Mary’s been a lot
moodier than usual. And just the other day, Mary’s mother caught a glimpse of Mary’s
forearms and saw that they had scratches and cuts all over them. Like most parents might
feel in such a situation, Mary’s mother was overwhelmed, feeling scared and confused:
“This is terrible! I’ve no idea how to deal with this! What am I supposed to do!!??”

What is self harm?

Self-harm (also called ‘non-suicidal self-harm’) happens when youth try to hurt themselves
on purpose. In most cases, they do this with no intention to commit suicide.

This fact sheet focuses on the kind of self-harm behaviours where youth do not intend to end their lives.

Common ways that youth (who do not have developmental delays or autism) harm themselves include:

Cutting themselves
Scratching themselves
Burning their skin, e.g. with a cigarette
Taking too much medication, but not enough to kill themselves (‘minor overdosing’)
Hitting one’s head (like against a wall)

How common are self-harm behaviours?

One study of Canadian youth found that almost 2 out of every 10 youth aged 14-21 had hurt themselves on purpose at
one time or another. Self-injury behaviours usually start between 13 and 15 years of age, and happen most often in
teenagers and young adults. Self-harm behaviours are twice as common in girls and young women, compared to
males.

Why do people self-harm?

Many mental health professionals believe that in most cases, youth are using self-harm behaviours as a way to try to
cope with stress. Some of the reasons behind self-harm include:

• Getting relief from painful or distressing feelings

• Dealing with feelings of numbness
• Communicating pain or distress to others

All of these underlying reasons are actually quite healthy; it’s just that self-harm is an unhealthy way to achieve these
goals.

401 Smyth Rd, Ottawa, Ontario, Canada 613-737-7600 . http://www.cheo.on.ca

P4926E July 2010
 How do self-harm behaviours develop?
Researchers (lead by N. Slee, in 2008) have mapped out a model to help us understand how self-harm
behaviours develop:

Self harm happens more often in people who have:

1
Vulnerable person
• Family members who have self harmed
• Lived through negative or very difficult experiences

&
Common internal stresses (handling feelings):

• A lack of feelings (feeling numb or empty)

Stressful event or • Too many (distressing) feelings like anger, anxiety or depression
situation
The vulnerable person
experiences internal or
Common external stressors are:
external stresses.
• School (teachers, school work, peers)

• Relationships (boyfriends, girlfriends, friends, parents, brothers and sisters)

■
Home (dealing with parents, divorce, separation, living in foster care
or a group home, conflict with siblings)

Stress triggers unhealthy Healthier thoughts:

thoughts: “I don’t like what she said... I’m going
“I can’t believe that she said to take a break so I can calm down,
that! Nobody loves me! Nobody and then I’ll deal with it. I’m not
cares! I can’t deal with this!” going to let this bother me...”

Coping
\' /
Can be healthy or
unhealthy. Unhealthy Coping, like Self-Harm Healthier coping behaviour, like:
Youth use self-harm because they • Calling a friend for support
• Feel overwhelmed • Going to work out
• Haven’t yet learned healthier ways to • Listening to music
cope • Writing in a diary
On the positive side - at least they are trying • Dealing with the stress
to cope!

For example, youth who feel numb or empty may cut to deal with these feelings. Or if they are feeling
overwhelmed by their emotions, self-harm helps them turn the emotional pain into physical pain.

As youth harm themselves more often, the link between external stress and self-harm behaviours gets
weaker. This means that after a while, a teen’s thoughts alone can become a trigger for self-harm. For
example, just thinking, “No one cares about me” can lead to self-harm, without any stressful event at all.

401 Smyth Rd, Ottawa, Ontario, Canada 613-737-7600 • http://www.cheo.on.ca

P4926E July 2010
 N
r How is self-harm treated?
Self-harm behaviours are usually treated through ‘talk therapy’. Effective treatments for self-harm all include these
common elements:

Pin pointing ‘triggers’: Helping youth figure out what stresses may be leading to self-harm.
1
Improving problem-solving: Helping youth find better ways to deal with stressful situations (for example, using
distraction when stressed, or by changing the situation to reduce stress).

Learning to control emotions: Helping youth identify their feelings, and find healthier ways to handle them

3 (for example, taking a bath to relax or reading a good book to keep their minds off worries).

Changing unhealthy thoughts: Helping youth identify their unhelpful thoughts (for example, “nobody loves
4 me”) and replace them with more positive ones (like, “its okay, I can get through this”)

Boosting ‘people’ skills: Helping youth communicate better so that they can handle conflicts and get support

5 from others, instead of using self-harm

Should we get professional help?

If you think your teen may be harming himself, take him to see a mental health professional (psychologist, doctor or
children’s mental health centre). Self-harm is mostly your teen’s way of coping with stress, and is not the same as
trying to end her life. But these behaviours can continue over time if the underlying stresses are not properly handled.
In some cases, self-harm can even progress to active thoughts of suicide. For this reason, it’s important for a
professional to assess your teen carefully to look for thoughts of suicide. In emergencies, contact a telephone crisis
line, or local hospital emergency room.

Helping a child or teen who self harms (short term)

While effective treatment can take a while, there are many things you can do to help your child or teen right now:

Show you care. Let your child or teen know that you care, “I love you and I’m worried about you.”

Accept your teen’s feelings. Remember that your child or teen may be feeling very stressed or upset. Ask,
“How can I help?” or “How can I support you?”

Learn basic First Aid. Learn how to take care of any cuts or other self-injuries. For minor cuts or injuries,
wash with mild soap and water so that they don’t get infected. For more serious cutting that may need
medical care (like stitches), offer to take your child or teen to the nearest walk-in clinic, doctor’s office, or
hospital emergency room.

Be non-judgmental. Let your child or teen know that if they want to talk about their self-harm (and
stress), that you are ready to listen without judging. You might say: “I’m worried about you. If there’s
something you want to talk about, let me know. I promise I’ll listen, and I won’t get upset or angry with
you, no matter what it is. I love you no matter what.”

Suggest distractions. While distractions are not long-term solutions, they can be good alternatives to self-
harm in the short term.

401 Smyth Rd, Ottawa, Ontario, Canada 613-737-7600 . http://www.cheo.on.ca

P4926E July 2010
 ‘Self soothing’ strategies: Here are some ideas youth can try when they are feeling stressed.
y.....
.••• •*:...... .
Sound
*; Smell
I
... v">... v Cm,....Listening to soothing music ...............■'*
..i
Incense or scented A
candles, potpourri
/
y"
Touch
Massage A
•v. V.v./iV
© Q \,J Y baths with scented
soap
\
.A
: ....
*%!UL'
r
V
:
, Warm baths or
rnlH chnwpr-:
'*•. /.*......
‘f ’’ WfWV
••••
A
........"*

'**v'^*« A
......... .. >...........
•V y
•-V. jr. *i *•

...... . i
Movement
Oral Walking, working out, hitting a
Chewing gum, : pillow, ripping newspaper or
drinking ice water, \ J / magazines, smashing play-doh,
throwing ice against a brick wall, y*
: crunching ice r’
V. •••. rianrlno stnmnino in heaw shops
....

What doesn’t help

Avoid guilt trips. Making your child or teen feel guilty or ashamed will not help. Showing youth how disgusted or
repulsed you are by their behaviour will not help either. This can make youth feel bad about themselves, cause them to
lose trust in you and not want to be with you.

Don’t tell your child or teen to ‘just stop’ self-harming. Self-harm is a way of coping. It can even be dangerous to
take away your child or teen’s way of coping when they haven’t yet learned healthier ways to cope. Without a way to
cope, your child or teen may act on impulses to end his/her life. At the very least, telling your teen to ‘just stop’ can
make it hard for your teen to trust you.

Supporting a child or teen over the long-term

Ask your child or teen about stresses that might be adding to the cutting (or other self-harm). Try saying something
like,

or “What makes you feel like or, i “What’s the problem that
“What’s the problem that
makes you feel like hurting yourself?” | made you feel like hurting
hurting yourself?” | yourself yesterday?”
’■f
............. /•.... ..........
.*• ....

If your child responds, “I don’t know!”, list some choices: “Well, people your age are often stressed about school (like
teachers, school work and classmates), home (like brothers, sisters and parents), or friends (like boyfriends and
girlfriends).”

You could then go through each one in more detail. You might say: “So how are things at school? How are the teachers?
How are you finding the school work?”

Help your child or teen to solve problems that are causing stress.

1. Find goals or solutions: Ask, “What do you wish could be different (with the stress or ‘trigger’)?”
2. Come up with possible solutions to try: Ask, “What could we try? What could you try?”
3. Try out a solution: Ask, “What would you like to try first?”
4. Evaluate whether or not the solution helped: Ask, “How do you think that worked out?”
5. If it didn’t work, try something different: Ask, “What other things could we try instead?”
6. If it helped, keep on doing it: Say, “It looks like that worked-what shall we keep on doing, then?”

401 Smyth Rd, Ottawa, Ontario, Canada 613-737-7600 • http://vww.cheo.on.ca

P4926E July 2010
y
r“Extreme Parenting” Styles and Self-Harm
No matter what stresses led to the self-harm, positive parenting can help. Parenting styles that are at the
extremes may add to stress for not only youth, but also for parents. The challenge is to find a balance between two
opposing extremes. On the one side, being too permissive (parent educator Barbara Coloroso calls this being a
‘jellyfish’), and on the other, being too authoritarian (Coloroso calls this being a ‘brick wall’). The middle ground is a
‘backbone’ parent, or being ‘authoritative’.

Too authoritarian
Too permissive
Too many rules
Not enough rules
Too concerned
Not concerned enough
Taking behaviour
Not taking problem problems too seriously
behaviours seriously
Being over protective
Not protecting enough
Not giving enough
Giving too much
independence Authoritative Balance independence

Children and youth do best when parents try to find an “authoritative” balance.
This means:

1. Giving your children and youth guidance and rules so they can figure out how to be responsible.
2. Giving your children and youth more freedom as they show more responsibility.
3. Spending time with your children and youth, talking, doing activities or just hanging out to build a healthy
relationship.

How do I handle it if my teen threatens self-harm?

It is only natural that some youth who self-harm may try to use it to get more privileges, or to escape consequences.
For example, a teen may say, “I’m going to feel depressed and cut myself if you don’t let me hang out with my friend
this weekend.”

If you are feeling manipulated or pressured into doing something unreasonable, then ask yourself, “What would be the
normal rules and limits for any other child?” If you feel your rules are fair, then don’t give in. By giving in, you end up
supporting the unhealthy part of your teen.

As the responsible parent, you might say something like: “I’m sorry if you don’t agree, but it’s fair to expect you to be
back by curfew time. It would be unhealthy for you if we didn’t have reasonable rules.”

At the same time, if your child is truly feeling overwhelmed from having too many things she must do, it makes sense
to go easy for a bit. You might say, “I know that you’re a bit overwhelmed these days. So how about this - instead of
having to take the dog out every day and do the dishes, you only have to do one of those things for the time being. You
can choose which one you want to keep doing for now.”

401 Smyth Rd, Ottawa, Ontario, Canada 613-737-7600 • http://www.cheo.on.ca

P4926E July 2010

J
r “What’s happening with Mary?” Part 2
After seeing the cuts and scratches on Mary’s arm, Mary’s mother wasn’t sure what to do. Mary
could see her mother was upset and broke down crying. “Mom, I would have told you sooner, it’s
just that I thought you’d get angry at me.” Mary’s mother didn’t know what to say at first, so she

1
just looked at Mary and gave her a hug. “Mary, I love you. Whatever it is, we’ll get through this.
Now tell me what’s been going on...” Mary told her mother about the stresses she’d been going
through. Her mother called the local crisis line and spoke with a crisis counsellor who asked her
some questions to make sure that Mary would be safe that night. (Had there been concerns, Mary’s
mother would have taken Mary to the local hospital Emergency Room, or called 911). The crisis
counsellor gave them a number of a local children’s mental health centre to call the next day. Just
to be sure, Mary’s mother also booked an appointment with her family doctor the following week.

Mary eventually started to see a mental health professional, and received counselling and therapy.
Together, they worked on using healthier ways to cope with her stresses and handle her feelings.
It’s now several months later and summertime, and Mary is wearing T-shirts again...

Where to find help in Eastern Ontario

In a crisis? Child, Youth and Family Crisis Line for Eastern Ontario, 613-260-2360 or toll-free, 1-877-377-7775
□
Looking for mental health help? www.eMentalHealth.ca is a bilingual directory of mental health services
□ and resources for Ottawa, Eastern Ontario and Canada.

Renfrew County: Phoenix Centre for Children, Youth and Families, with offices in Renfrew and Pembroke.'
□ 613-735-2374 or toll-free 1-800-465-1870, www.renc.igs.net/-phoenix

Leeds and Grenville County: Child and Youth Wellness Centre, with offices in Brockville, Elgin, Gananoque
□ and Prescott. 613-498-4844, www.cywc.net

Lanark County: Open Doors for Lanark Children and Youth, with offices in Carleton Place,
□ Smiths Falls and Perth. 613-283-8260, www.opendoors.on.ca

To find a Psychologist anywhere in Ontario: College of Psychologists of Ontario, 1-800-489-8388,

□ www.cpo.on.ca

Where to find help in Ottawa

Youth Services Bureau, for ages 12-20, 613-562-3004

□
Family Service Centre of Ottawa, 613-725-3601, www.familyservicesottawa.org
□
Catholic Family Services, 613-233-8418, www.cfssfc-ottawa.org
□
Jewish Family Services, 613-722-2225, www.jfsottawa.com
□
The Children’s Hospital of Eastern Ontario and the Royal Ottawa Mental Health Centre (by physician’s
□ referral), 613-737-7600 ext. 2496. For more information on our programs, www.cheo.on.ca

To find a Psychologist in Ottawa: Call the Ottawa Academy of Psychology referral service, 613-235-2529.
□ Listing many, but not all, Ottawa psychologists, www.ottawa-psychologists.org/find.htm

401 Smyth Rd, Ottawa, Ontario, Canada 613-737-7600 • http://www.cheo.on.ca

P4926E July 2010